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32 emner vises.
John Turnidge, Iain J. Abbott
Clinical Microbiology and Infection, 13.12.2021
Tilføjet 14.12.2021
After three years of internal discussion and external international consultation [1], EUCAST introduced revised definitions of susceptibility test categories [2]. Its primary aim was to eliminate the ambiguity associated with the old “intermediate (I)” category, which could variously mean one of four things: uncertain therapeutic effect, susceptible if higher dosages are used, susceptible if the agent is concentrated at the site of infection, a buffer zone to reduce mis-categorisation due to technical factors (natural assay variation).
Læs mere Tjek på PubMedChengzuo Xie, Haojie Ding, Jianzu Ding, Yangji Xue, Shaohong Lu, Hangjun Lv
Journal of Medical Virology, 14.12.2021
Tilføjet 14.12.2021
Kenneth Iregbu, Angela Dramowski, Rebecca Milton, Emmanuel Nsutebu, Stephen R C Howie, Mallinath Chakraborty, Pascal M Lavoie, Ceire E Costelloe, Peter Ghazal
Lancet Infectious Diseases, 14.12.2021
Tilføjet 14.12.2021
Neonates and children in low-income and middle-income countries (LMICs) contribute to the highest number of sepsis-associated deaths globally. Interventions to prevent sepsis mortality are hampered by a lack of comprehensive epidemiological data and pathophysiological understanding of biological pathways. In this review, we discuss the challenges faced by LMICs in diagnosing sepsis in these age groups. We highlight a role for multi-omics and health care data to improve diagnostic accuracy of clinical algorithms, arguing that health-care systems urgently need precision medicine to avoid the pitfalls of missed diagnoses, misdiagnoses, and overdiagnoses, and associated antimicrobial resistance.
Læs mere Tjek på PubMedKaren H Keddy, Senjuti Saha, Samuel Kariuki, John Bosco Kalule, Farah Naz Qamar, Zoya Haq, Iruka N Okeke
Lancet Infectious Diseases, 14.12.2021
Tilføjet 14.12.2021
Diarrhoea is an important cause of morbidity and mortality in children from low-income and middle-income countries (LMICs), despite advances in the management of this condition. Understanding of the causes of diarrhoea in children in LMICs has advanced owing to large multinational studies and big data analytics computing the disease burden, identifying the important variables that have contributed to reducing this burden. The advent of the mobile phone has further enabled the management of childhood diarrhoea by providing both clinical support to health-care workers (such as diagnosis and management) and communicating preventive measures to carers (such as breastfeeding and vaccination reminders) in some settings.
Læs mere Tjek på PubMedMalaria Journal, 13.12.2021
Tilføjet 14.12.2021
Abstract
Background
Molecular diagnostic tools have been incorporated in insecticide resistance monitoring programmes to identify underlying genetic basis of resistance and develop early warning systems of vector control failure. Identifying genetic markers of insecticide resistance is crucial in enhancing the ability to mitigate potential effects of resistance. The knockdown resistance (kdr) mutation associated with resistance to DDT and pyrethroids, the acetylcholinesterase-1 (ace-1R) mutation associated with resistance to organophosphates and carbamates and 2La chromosomal inversion associated with indoor resting behaviour, were investigated in the present study.
Methods
Anopheles mosquitoes sampled from different sites in Kenya and collected within the context of malaria vector surveillance were analysed. Mosquitoes were collected indoors using light traps, pyrethrum spray and hand catches between August 2016 and November 2017. Mosquitoes were identified using morphological keys and Anopheles gambiae sensu lato (s.l.) mosquitoes further identified into sibling species by the polymerase chain reaction method following DNA extraction by alcohol precipitation. Anopheles gambiae and Anopheles arabiensis were analysed for the presence of the kdr and ace-1R mutations, while 2La inversion was only screened for in An. gambiae where it is polymorphic. Chi-square statistics were used to determine correlation between the 2La inversion karyotype and kdr-east mutation.
Results
The kdr-east mutation occurred at frequencies ranging from 0.5 to 65.6% between sites. The kdr-west mutation was only found in Migori at a total frequency of 5.3% (n = 124). No kdr mutants were detected in Tana River. The ace-1R mutation was absent in all populations. The 2La chromosomal inversion screened in An. gambiae occurred at frequencies of 87% (n = 30), 80% (n = 10) and 52% (n = 50) in Baringo, Tana River and Migori, respectively. A significant association between the 2La chromosomal inversion and the kdr-east mutation was found.
Conclusion
The significant association between the 2La inversion karyotype and kdr-east mutation suggests that pyrethroid resistant An. gambiae continue to rest indoors regardless of the presence of treated bed nets and residual sprays, a persistence further substantiated by studies documenting continued mosquito abundance indoors. Behavioural resistance by which Anopheles vectors prefer not to rest indoors may, therefore, not be a factor of concern in this study’s malaria vector populations.
Læs mere Tjek på PubMedInfection, 13.12.2021
Tilføjet 13.12.2021
Abstract
Purpose
The Coronavirus disease 2019 (COVID-19) pandemic is one of the most devastating global problems. Regarding the lack of disease-specific treatments, repurposing drug therapy is currently considered a promising therapeutic approach in pandemic situations. Recently, the combination therapy of Janus kinase (JAK) inhibitor baricitinib has been authorized for emergency COVID-19 hospitalized patients; however, this strategy's safety, drug-drug interactions, and cellular signaling pathways remain a tremendous challenge.
Methods
In this study, we aimed to provide a deep insight into the baricitinib combination therapies in severe COVID-19 patients through reviewing the published literature on PubMed, Scopus, and Google scholar databases. We also focused on cellular and subcellular pathways related to the synergistic effects of baricitinib plus antiviral agents, virus entry, and cytokine storm (CS) induction. The safety and effectiveness of this strategy have also been discussed in moderate to severe forms of COVID-19 infection.
Results
The severity of COVID-19 is commonly associated with a dysregulated immune response and excessive release of pro-inflammatory agents, resulting in CS. It has been shown that baricitinib combined with antiviral agents could modulate the inflammatory response and provide a series of positive therapeutic outcomes in hospitalized adults and pediatric patients (age ≥ two years old).
Conclusion
Baricitinib plus the standard of care treatment might be a potential strategy in hospitalized patients with severe COVID-19.
Læs mere Tjek på PubMedOng, K. I. C., Khattignavong, P., Keomalaphet, S., Iwagami, M., Brey, P., Kano, S., Jimba, M.
BMJ Open, 13.12.2021
Tilføjet 13.12.2021
Objectives
This mixed methods study was conducted to explore the barriers and facilitators for health-seeking behaviours in a malaria endemic district in Lao PDR.
Design
A convergent mixed methods design.
Setting
Two malaria endemic villages in Thapangthong district, Savannakhet Province, Lao PDR.
Participants
Villagers and healthcare workers in the two villages in Thapangthong district.
Methods
In the quantitative part, a pretested questionnaire was used to identify the health-seeking behaviours of the villagers. In the qualitative part, focus group discussions were employed to explore health-seeking behaviours of the villagers and in-depth interviews were used to explore the perceptions of the healthcare workers. Descriptive statistics were computed and multiple logistic regressions were used to identify the factors associated with perceived severity and perceived susceptibility. Thematic analysis was used to analyse the qualitative data. Quantitative and qualitative results were integrated in joint displays.
Results
In the quantitative part, data were collected from 313 villagers from both villages. For malaria, 96.0% and 98.2% of villagers from villages A and B, respectively, would first seek treatment at public health facilities. Villagers who have not experienced malaria before were more likely to perceive that the consequences of malaria were serious compared with those who have experienced malaria before (adjusted OR=1.69, 95% CI: 1.03 to 2.75). However, qualitative data showed that villagers faced problems such as lack of medicines and medical equipment. Healthcare workers also mentioned the lack of manpower and equipment in the in-depth interviews. Nevertheless, villagers still preferred to seek treatment at the health center as the National Health Insurance was introduced.
Conclusions
Public health facility usage was high but barriers existed. Effective policy and enabling environment such as the introduction of the National Health Insurance could help accelerate the progress towards the malaria elimination goal. Moreover, the benefits could go beyond the context of malaria.
Læs mere Tjek på PubMedSpiers, J., Buszewicz, M., Chew-Graham, C., Dunning, A., Taylor, A. K., Gopfert, A., Van Hove, M., Teoh, K. R.-H., Appleby, L., Martin, J., Riley, R.
BMJ Open, 13.12.2021
Tilføjet 13.12.2021
Objectives
This paper reports findings exploring junior doctors’ experiences of working during the COVID-19 pandemic in the UK.
Design
Qualitative study using in-depth interviews with 15 junior doctors. Interviews were audio-recorded, transcribed, anonymised and imported into NVivo V.12 to facilitate data management. Data were analysed using reflexive thematic analysis.
Setting
National Health Service (NHS) England.
Participants
A purposive sample of 12 female and 3 male junior doctors who indicated severe depression and/or anxiety on the DASS-21 questionnaire or high suicidality on Paykel’s measure were recruited. These doctors self-identified as having lived experience of distress due to their working conditions.
Results
We report three major themes. First, the challenges of working during the COVID-19 pandemic, which were both personal and organisational. Personal challenges were characterised by helplessness and included the trauma of seeing many patients dying, fears about safety and being powerless to switch off. Work-related challenges revolved around change and uncertainty and included increasing workloads, decreasing staff numbers and negative impacts on relationships with colleagues and patients. The second theme was strategies for coping with the impact of COVID-19 on work, which were also both personal and organisational. Personal coping strategies, which appeared limited in their usefulness, were problem and emotion focused. Several participants appeared to have moved from coping towards learnt helplessness. Some organisations reacted to COVID-19 collaboratively and flexibly. Third, participants reported a positive impact of the COVID-19 pandemic on working practices, which included simplified new ways of working—such as consistent teams and longer rotations—as well as increased camaraderie and support.
Conclusions
The trauma that junior doctors experienced while working during COVID-19 led to powerlessness and a reduction in the benefit of individual coping strategies. This may have resulted in feelings of resignation. We recommend that, postpandemic, junior doctors are assigned to consistent teams and offered ongoing support.
Læs mere Tjek på PubMedMohamed, S. F., Uthman, O. A., Mutua, M. K., Asiki, G., Abba, M. S., Gill, P.
BMJ Open, 13.12.2021
Tilføjet 13.12.2021
Background
The burden of uncontrolled hypertension in sub-Saharan Africa (SSA) is high and hypertension is known to coexist with other chronic diseases such as kidney disease, diabetes among others. This is the first systematic review and meta-analysis to determine the burden of uncontrolled hypertension among patients with comorbidities in SSA.
Methods
A comprehensive search was conducted on MEDLINE, Excerpta Medica Database (Embase) and Web of Science to identify all relevant articles published between 1 January 2000 and 17 June 2021. We included studies that reported on the prevalence of uncontrolled hypertension among people in SSA who report taking antihypertensive treatment and have another chronic condition. A random-effects meta-analysis was performed to obtain the pooled estimate of the prevalence of uncontrolled hypertension among patients with comorbid conditions while on treatment across studies in SSA.
Results
In all, 20 articles were included for meta-analyses. Eleven articles were among diabetic patients, five articles were among patients with HIV, two were among patients with stroke while chronic kidney disease and atrial fibrillation had one article each. The pooled prevalence of uncontrolled hypertension among patients with comorbidities was 78.6% (95% CI 71.1% to 85.3%); I² 95.9%, varying from 73.1% in patients with stroke to 100.0% in patients with atrial fibrillation. Subgroup analysis showed differences in uncontrolled hypertension prevalence by various study-level characteristics
Conclusion
This study suggests a high burden of uncontrolled hypertension in people with comorbidities in SSA. Strategies to improve the control of hypertension among people with comorbidities are needed.
PROSPERO registration number
CRD42019108218.
Læs mere Tjek på PubMedLou, B., Guo, J., Liu, Y., Xiong, C., Shi, J., Zhou, C.
BMJ Open, 13.12.2021
Tilføjet 13.12.2021
Introduction
Previous studies have shown mixed results that delirium may result in a high risk of adverse clinical outcomes in patients with COVID-19. The aim of this meta-analysis is to summarise the evidence of prevalence, classification, risk factors and outcomes impact of delirium in adult patients with COVID-19.
Methods
A systematic search will be performed in PubMed, EMBase, ISI Knowledge via Web of Science and preprint databases (MedRxiv and BioRxiv) (from inception until June 2021) to identify all cohort studies concerning delirium in adult patients with COVID-19. The primary outcome will be the prevalence of delirium with different classifications (hyperactive, hypoactive or mixed type). The secondary outcomes will include the association of risk factors and the association with all-cause mortality during hospitalisation. Univariable or multivariable meta-regression and subgroup analyses will be conducted for the study design and patient characteristics. Sensitivity analyses were used to assess the robustness of our results by removing each included study at one time to obtain and evaluate the remaining overall estimates of primary and secondary outcomes.
Ethics and dissemination
Ethical approval is not an essential element for the systematic review protocol in accordance with the Institutional Review Board /Independent Ethics Committee of Beijing Hospital. This meta-analysis will be disseminated through a peer-reviewed journal for publication.
PROSPERO registration number
CRD42020224871.
Læs mere Tjek på PubMedJiang, J., Wan, R., He, S., Wu, Y., Shen, Z., Chen, G., Sun, S., Yan, W., Zheng, S.
BMJ Open, 13.12.2021
Tilføjet 13.12.2021
Objectives
Biliary atresia (BA) is regarded as a serious neonatal hepatobiliary disease, and its aetiology and pathogenesis remain unclear. Epidemiological studies are limited, especially for the data from China. This study aims to explore risk factors of BA and provide new evidence to improve understanding of its aetiology.
Design
This is a case–control study from 1 January 2015 to 31 December 2016.
Setting
Cases were consecutively recruited from an urban tertiary care academic children’s hospital in Shanghai, China, while the controls were recruited from a community hospital in Shanghai through a random sampling system.
Participants
721 patients suspected for BA who planned to take the diagnostic surgery were enrolled preoperatively. 613 were diagnosed with BA and recruited into the case group. Meanwhile, 688 infants without any observed major congenital anomalies or jaundice were enrolled. Finally, 594 valid questionnaires from the case group and 681 from the control group were obtained.
Primary and secondary outcome measures
Standardised questionnaires were used for data collection. Multivariate logistic regression analysis was performed to evaluate associations reported as ORs and precision, by adjusting covariates.
Results
Anxiety or stress during pregnancy was strongly associated with increased risk of BA (OR 8.36 (95% CI: 4.08 to 17.15); p<0.001), respectively. Lower birth weight, fathers from ethnic minorities of China, older age of fathers, lower income of parents, and exposure to infection, diseases and medication during pregnancy all made differences.
Conclusions
Social factors including the educational and economic background and its related anxiety and stress during pregnancy might be noticed in the occurrence of BA. Maternal infections during pregnancy in the prevalence of BA were demonstrated.
Trial registration number
ChiCTR-IPR-15005885.
Læs mere Tjek på PubMedPragman, A. A., Fieberg, A. M., Reilly, C. S., Wendt, C.
BMJ Open, 13.12.2021
Tilføjet 13.12.2021
Objectives
Determine the effect of twice-daily chlorhexidine oral rinses on oral and lung microbiota biomass and respiratory symptoms.
Setting
Single centre.
Participants
Participants were aged 40–85 with chronic obstructive pulmonary disease (COPD) and chronic productive cough or COPD exacerbation within the last year. Exclusions included antibiotics in the previous 2 months and/or those with less than four teeth. Forty-four participants were recruited and 40 completed the study.
Intervention
Participants were randomised 1:1 to twice-daily 0.12% chlorhexidine oral rinses versus placebo for 2 months along with daily diaries. St. George’s Respiratory Questionnaire (SGRQ), blood tests, oral rinse and induced sputum were collected at randomisation and the final visit.
Primary and secondary outcomes
Primary outcome was a change in oral and sputum microbiota biomass. Secondary outcomes included: sputum and oral microbiota Shannon and Simpson diversity and taxonomy; inflammatory markers; Breathlessness, Cough and Sputum Scale and SGRQ scores.
Results
Neither the oral microbiota nor the sputum microbiota biomass decreased significantly in those using chlorhexidine compared with placebo (oral microbiota mean log10 difference (SE)=–0.103 (0.23), 95% CI –0.59 to 0.38, p=0.665; sputum microbiota 0.80 (0.46), 95% CI –0.15 to 1.75, p=0.096). Chlorhexidine decreased both oral and sputum microbiota alpha (Shannon) diversity (linear regression estimate (SE) oral: –0.349 (0.091), p=0.001; sputum –0.622 (0.169), p=0.001). Chlorhexidine use did not decrease systemic inflammatory markers compared with placebo (C reactive protein (chlorhexidine 1.8±7.5 vs placebo 0.4±6.8, p=0.467), fibrinogen (22.5±77.8 vs 10.0±77.0, p=0.406) or leucocytes (0.2±1.8 vs 0.5±1.8, p=0.560)). Chlorhexidine use decreased SGRQ scores compared with placebo (chlorhexidine –4.7±8.0 vs placebo 1.7±8.9, p=0.032).
Conclusions
We did not detect a significant difference in microbiota biomass due to chlorhexidine use. Chlorhexidine decreased oral and sputum microbiota alpha diversity and improved respiratory health-related quality of life compared with placebo.
Trial registration
NCT02252588.
Læs mere Tjek på PubMedPartinen, M., Holzinger, B., Morin, C. M., Espie, C., Chung, F., Penzel, T., Benedict, C., Bolstad, C. J., Cedernaes, J., Chan, R. N. Y., Dauvilliers, Y., De Gennaro, L., Han, F., Inoue, Y., Matsui, K., Leger, D., Cunha, A. S., Merikanto, I., Mota-Rolim, S., Nadorff, M., Plazzi, G., Schneider, J., Sieminski, M., Wing, Y.-K., Bjorvatn, B.
BMJ Open, 13.12.2021
Tilføjet 13.12.2021
Objectives
Sleep is important for human health and well-being. No previous study has assessed whether the COVID-19 pandemic impacts sleep and daytime function across the globe.
Methods
This large-scale international survey used a harmonised questionnaire. Fourteen countries participated during the period of May–August 2020. Sleep and daytime problems (poor sleep quality, sleep onset and maintenance problems, nightmares, hypnotic use, fatigue and excessive sleepiness) occurring ‘before’ and ‘during’ the pandemic were investigated. In total, 25 484 people participated and 22 151 (86.9%) responded to the key parameters and were included. Effects of COVID-19, confinement and financial suffering were considered. In the fully adjusted logistic regression models, results (weighted and stratified by country) were adjusted for gender, age, marital status, educational level, ethnicity, presence of sleep problems before COVID-19 and severity of the COVID-19 pandemic in each country at the time of the survey.
Results
The responders were mostly women (64%) with a mean age 41.8 (SD 15.9) years (median 39, range 18–95). Altogether, 3.0% reported having had COVID-19; 42.2% reported having been in confinement; and 55.9% had suffered financially. All sleep and daytime problems worsened during the pandemic by about 10% or more. Also, some participants reported improvements in sleep and daytime function. For example, sleep quality worsened in about 20% of subjects and improved in about 5%. COVID-19 was particularly associated with poor sleep quality, early morning awakening and daytime sleepiness. Confinement was associated with poor sleep quality, problems falling asleep and decreased use of hypnotics. Financial suffering was associated with all sleep and daytime problems, including nightmares and fatigue, even in the fully adjusted logistic regression models.
Conclusions
Sleep problems, fatigue and excessive sleepiness increased significantly worldwide during the first phase of the COVID-19 pandemic. Problems were associated with confinement and especially with financial suffering.
Læs mere Tjek på PubMedSentis, A., Montoro-Fernandez, M., Lopez-Corbeto, E., Egea-Cortes, L., Nomah, D. K., Diaz, Y., Garcia de Olalla, P., Mercuriali, L., Borrell, N., Reyes-Uruena, J., Casabona, J., The Catalan HIV and STI Surveillance Group, Sentis, Lopez, Gonzalez, Lugo, Bonamusa, Reyes, Casabona, Garcia de Olalla, Mercuriali, Masdeu, Ros, Rius, Company, Danes, Camps, Vileu, Ferrus, Borrell, Minguell, Ferras, Parron, Modol, Martinez, Godoy, Tarres, J Perez, Boldu, Barrabeig, Donate, Clotet, Sala, Carol, Guadalupe-Fernandez, Mendioroz, Ciruela, Carmona, Mansilla, Martinez, Hernandez
BMJ Open, 13.12.2021
Tilføjet 13.12.2021
Objectives
To describe the epidemiology of sexually transmitted infections (STIs), identify and characterise socio-epidemiological clusters and determine factors associated with HIV coinfection.
Design
Retrospective population-based cohort.
Setting
Catalonia, Spain.
Participants
42 283 confirmed syphilis, gonorrhoea, chlamydia and lymphogranuloma venereum cases, among 34 600 individuals, reported to the Catalan HIV/STI Registry in 2017–2019.
Primary and secondary outcomes
Descriptive analysis of confirmed STI cases and incidence rates. Factors associated with HIV coinfection were determined using logistic regression. We identified and characterized socio-epidemiological STI clusters by Basic Health Area (BHA) using K-means clustering.
Results
The incidence rate of STIs increased by 91.3% from 128.2 to 248.9 cases per 100 000 population between 2017 and 2019 (p<0.001), primarily driven by increase among women (132%) and individuals below 30 years old (125%). During 2017–2019, 50.1% of STIs were chlamydia and 31.6% gonorrhoea. Reinfections accounted for 10.8% of all cases and 6% of cases affected HIV-positive individuals. Factors associated with the greatest likelihood of HIV coinfection were male sex (adjusted OR (aOR) 23.69; 95% CI 16.67 to 35.13), age 30–39 years (versus <20 years, aOR 18.58; 95% CI 8.56 to 52.13), having 5–7 STI episodes (vs 1 episode, aOR 5.96; 95% CI 4.26 to 8.24) and living in urban areas (aOR 1.32; 95% CI 1.04 to 1.69). Living in the most deprived BHAs (aOR 0.60; 95% CI 0.50 to 0.72) was associated with the least likelihood of HIV coinfection. K-means clustering identified three distinct clusters, showing that young women in rural and more deprived areas were more affected by chlamydia, while men who have sex with men in urban and less deprived areas showed higher rates of STI incidence, multiple STI episodes and HIV coinfection.
Conclusions
We recommend socio-epidemiological identification and characterisation of STI clusters and factors associated with HIV coinfection to identify at-risk populations at a small health area level to design effective interventions.
Læs mere Tjek på PubMedReid, J. C., Costa, A. P., Duong, M., Ho, T., Kruisselbrink, R., Raina, P., Kirkwood, R., Jones, A., Corriveau, S., Griffith, L. E., Haider, S., Marcucci, M., Markle-Reid, M., Morrison, H., Raghavan, N., Schumacher, C., Vrkljan, B., Junek, M., Martin, L., Patel, A., Girolametto, C., Pitre, T., Beauchamp, M. K., On behalf of the COREG Investigators
BMJ Open, 13.12.2021
Tilføjet 13.12.2021
Introduction
COVID-19 is an international public health crisis with more than 132 million infections worldwide. Beyond acute infection, emerging data indicate patients diagnosed with COVID-19 may experience persistent sequelae similar to survivors of sepsis or acute respiratory syndromes, including mobility limitations and fatigue. However, there is limited evidence on the trajectory of functional recovery in those hospitalised with COVID-19. The primary aim of the Coronavirus Registry Functional Recovery (COREG-FR) study is to understand the trajectory of functional recovery among individuals hospitalised for COVID-19 over the medium (up to 6 months) and longer term (6–12 months) that will guide clinical care and optimal management of serious COVID-19 illness and recovery.
Methods and analysis
COREG-FR is a multicentre longitudinal cohort study. We will enrol a minimum of 211 adults age 18 years and older with COVID-19 from five hospitals. Participants will be followed from admission to hospital as an inpatient, to hospital discharge, and at 3-month, 6-month, 9-month and up to 12-month post-hospital discharge. We will conduct telephone interviews at ward admission and discharge, and telephone interviews plus in-person assessments of physical function and lung function at all remaining follow-ups. Our primary outcome is the Activity Measure for Post-Acute Care mobility scale measured at all time points. We will conduct linear mixed effects regression analyses to explore determinants of functional outcomes after COVID-19 illness. Subgroup analyses based on age (≤65 vs >65 years), frailty status (Clinical Frailty Scale score ≤4 vs >5) and variants of concern will be conducted.
Ethics and dissemination
COREG-FR has been approved by Research Ethics Boards at participating sites. We will disseminate this work through peer-reviewed manuscripts, presentations at national and international meetings and through the established COREG website (www.coregontario.ca). COREG-FR is designed as a data platform for future studies evaluating COVID-19 recovery.
Trial registration number
NCT04602260; Pre-results.
Læs mere Tjek på PubMedAkingboye, A., Mahmood, F., Amiruddin, N., Reay, M., Nightingale, P., Ogunwobi, O. O.
BMJ Open, 13.12.2021
Tilføjet 13.12.2021
Objective
Susceptibility of patients with cancer to COVID-19 pneumonitis has been variable. We aim to quantify the risk of hospitalisation in patients with active cancer and use a machine learning algorithm (MLA) and traditional statistics to predict clinical outcomes and mortality.
Design
Retrospective cohort study.
Setting
A single UK district general hospital.
Participants
Data on total hospital admissions between March 2018 and June 2020, all active cancer diagnoses between March 2019 and June 2020 and clinical parameters of COVID-19-positive admissions between March 2020 and June 2020 were collected. 526 COVID-19 admissions without an active cancer diagnosis were compared with 87 COVID-19 admissions with an active cancer diagnosis.
Primary and secondary outcome measures
30-day and 90-day post-COVID-19 survival.
Results
In total, 613 patients were enrolled with male to female ratio of 1:6 and median age of 77 years. The estimated infection rate of COVID-19 was 87 of 22 729 (0.4%) in the patients with cancer and 526 of 404 379 (0.1%) in the population without cancer (OR of being hospitalised with COVID-19 if having cancer is 2.942671 (95% CI: 2.344522 to 3.693425); p<0.001). Survival was reduced in patients with cancer with COVID-19 at 90 days. R-Studio software determined the association between cancer status, COVID-19 and 90-day survival against variables using MLA. Multivariate analysis showed increases in age (OR 1.039 (95% CI: 1.020 to 1.057), p<0.001), urea (OR 1.005 (95% CI: 1.002 to 1.007), p<0.001) and C reactive protein (CRP) (OR 1.065 (95% CI: 1.016 to 1.116), p<0.008) are associated with greater 30-day and 90-day mortality. The MLA model examined the contribution of predictive variables for 90-day survival (area under the curve: 0.749); with transplant patients, age, male gender and diabetes mellitus being predictors of greater mortality.
Conclusions
Active cancer diagnosis has a threefold increase in risk of hospitalisation with COVID-19. Increased age, urea and CRP predict mortality in patients with cancer. MLA complements traditional statistical analysis in identifying prognostic variables for outcomes of COVID-19 infection in patients with cancer. This study provides proof of concept for MLA in risk prediction for COVID-19 in patients with cancer and should inform a redesign of cancer services to ensure safe delivery of cancer care.
Læs mere Tjek på PubMedPaul Adepoju
Nature, 13.12.2021
Tilføjet 13.12.2021
Nature Medicine, Published online: 13 December 2021; doi:10.1038/d41591-021-00073-x
As data emerge that boosters may help to protect against Omicron, the supply of vaccines to Africa is further squeezed. But fears of the COVID-19 variant may increase uptake, which is worryingly low in some countries.
Læs mere Tjek på PubMedSophie Brunner-Ziegler, Tibor Spath, Gabriela Kornek, Franz König, Bernhard Parschalk, Maximilian Schnetzinger, Robert Paul Straßl, Rebeka Savic, Andrea Foit, Helene Resch, Florian Thalhammer
Clinical Microbiology and Infection, 13.12.2021
Tilføjet 13.12.2021
The identification of SARS-CoV-2 antigen or RNA in respiratory specimens ≥14 days after administration of all recommended doses of authorized COVID-19 vaccines is defined as „breakthrough infection“. In the present investigation m-RNA and vector based SARS-CoV-2 vaccines were analysed with respect to postvaccination infections in vaccinated hospital employees.
Læs mere Tjek på PubMedAlessandra Borsetti, Fabio Scarpa, Antonello Maruotti, Fabio Divino, Giancarlo Ceccarelli, Marta Giovanetti, Massimo Ciccozzi
Journal of Medical Virology, 13.12.2021
Tilføjet 13.12.2021
Serge Ouoba, Mafumi Okimoto, Shintaro Nagashima, Yoshihiro Kitahara, Kei Miwata, Ko Ko, E Bunthen, Aya Sugiyama, Kazuaki Takahashi, Takemasa Sakaguchi, Toshiro Takafuta, Junko Tanaka
Journal of Medical Virology, 13.12.2021
Tilføjet 13.12.2021
Zhonglei Wang, Liyan Yang
Journal of Medical Virology, 13.12.2021
Tilføjet 13.12.2021
Lulan Wang, Genhong Cheng
Journal of Medical Virology, 13.12.2021
Tilføjet 13.12.2021
Alex Yee Chau Sim, Ainal Adlin Naffi, Tang Seng Fai, Najma Kori, Wan Asyraf Wan Zaidi, Petrick Periyasamy, Norshamsiah Md Din, Mushawiahti Mustapha, Ayesha Mohd Zain
Journal of Medical Virology, 13.12.2021
Tilføjet 13.12.2021
Jeffrey M. Rybak, Katherine S. Barker, José F. Muñoz, Josie E. Parker, Suhail Ahmad, Eiman Mokaddas, Aneesa Abdullah, Rehab S. Elhagracy, Steve L. Kelly, Christina A. Cuomo, P. David Rogers
Clinical Microbiology and Infection, 12.12.2021
Tilføjet 13.12.2021
Candida auris has emerged as a healthcare-associated and multidrug-resistant fungal pathogen of great clinical concern. While as many as 50% of C. auris clinical isolates are reported to be resistant to amphotericin B, to date, no mechanisms contributing to this resistance have been identified. Here we describe the clinical case in which high-level amphotericin B resistance was acquired in vivo during therapy and undertake molecular and genetic studies to identify and characterize the genetic determinant of resistance.
Læs mere Tjek på PubMedWan-Jie Gu, Jiao Huang, Hai-Yin Jiang
Clinical Microbiology and Infection, 12.12.2021
Tilføjet 12.12.2021
Viral reactivation is frequently detected in critically ill patients with mechanical ventilation and is associated with worse outcomes. However, the efficacy and safety of antiviral therapy in these patients remain unknown.
Læs mere Tjek på PubMedBMC Infectious Diseases, 11.12.2021
Tilføjet 12.12.2021
Abstract
Background
The four-component serogroup B meningococcal 4CMenB vaccine (Bexsero, GSK) has been routinely given to all infants in the United Kingdom at 2, 4 and 12 months of age since September 2015. After 3 years, Public Health England (PHE) reported a 75% [95% confidence interval 64%; 81%] reduction in the incidence of serogroup B invasive meningococcal disease (IMD) in age groups eligible to be fully vaccinated. In contrast, vaccine effectiveness (VE) evaluated in the same immunization program applying the screening method was not statistically significant. We re-analyzed the data using an incidence model.
Methods
Aggregate data—stratified by age, year and doses received—were provided by PHE: serogroup B IMD case counts for the entire population of England (years 2011–2018) and 4CMenB vaccine uptake in infants. We combined uptake with national population estimates to obtain counts of vaccinated and unvaccinated person-time by age and time. We re-estimated VE comparing incidence rates in vaccinated and non-vaccinated subjects using a Bayesian Poisson model for case counts with person-time data as an offset. The model was adjusted for age, time and number of doses received.
Results
The incidence model showed that cases decreased until 2013–2014, followed by an increasing trend that continued in the non-vaccinated population during the immunization program. VE in fully vaccinated subjects (three doses) was 80.1% [95% Bayesian credible interval (BCI): 70.3%; 86.7%]. After a single dose, VE was 33.5% [12.4%; 49.7%]95%BCI and after two doses, 78.7% [71.5%; 84.5%]95%BCI. We estimated that vaccination averted 312 cases [252; 368]95%BCI between 2015 and 2018. VE was in line with the previously reported incidence reduction.
Conclusions
Our estimates of VE had higher precision than previous estimates based on the screening method, which were statistically not significant, and in line with the 75% incidence reduction previously reported by PHE. When disease incidence is low and vaccine uptake is high, the screening method applied to cases exclusively from the population eligible for vaccination may not be precise enough and may produce misleading point-estimates. Precise and accurate VE estimates are fundamental to inform public health decision making. VE assessment can be enhanced using models that leverage data on subjects not eligible for vaccination.
Læs mere Tjek på PubMedAli Auzin, Menoeska Spits, Evelina Tacconelli, José Rodríguez-Baño, Marlies Hulscher, Eddy Adang, Andreas Voss, Heiman Wertheim
Clinical Microbiology and Infection, 12.12.2021
Tilføjet 12.12.2021
Antibiotic resistance requires continuous monitoring by experts to decide whether empiric antibiotic therapies (EAT) should be replaced by alternative antibiotics. The exact moment and criteria for this change is unclear and generally based on consensus between experts.
Læs mere Tjek på PubMedTakenao Koseki, Kazuki Nakajima, Hitoshi Iwasaki, Shigeki Yamada, Kazuo Takahashi, Yohei Doi, Tomohiro Mizuno
International Journal of Infectious Diseases, 12.12.2021
Tilføjet 12.12.2021
Favipiravir (FVP) is an oral RNA-dependent RNA polymerase inhibitor that is being evaluated as an antiviral for the treatment of coronavirus infectious disease 2019 (COVID-19) (Alam et al., 2021). In Japan, FVP was approved for the treatment of patients with novel or re-emerging pandemic influenza virus infection in 2011. It is well recognized that the administration of FVP frequently leads to elevated uric acid (UA) levels in patients with influenza virus infections (Pharmaceuticals and Medical Devices Agency (PMDA), 2014).
Læs mere Tjek på PubMedHong Ji, Huan Fan, Jing Ai, Chao Shi, Jun Bi, Yin-Hua Chen, Xiao-Peng Lu, Qin-Hui Chen, Jian-Mei Tian, Chang-jun Bao, Xue-feng Zhang, Yu Jin
International Journal of Infectious Diseases, 12.12.2021
Tilføjet 12.12.2021
Jacob Bor, Dorina Onoya, Bruce Richman, Kenneth H. Mayer
New England Journal of Medicine, 11.12.2021
Tilføjet 12.12.2021
Malaria Journal, 11.12.2021
Tilføjet 12.12.2021
Abstract
Background
A detailed analysis of household and individual level Plasmodium infection patterns in two low-endemic districts of Meghalaya was undertaken to better understand the epidemiology of malaria in northeast India.
Methods
Socio-demographic and behavioural information from residents (aged 1–69 years) of households were collected through pre-tested, questionnaire conducted in 2018 and 2019. Blood samples collected from participants were tested for Plasmodium falciparum and/or Plasmodium vivax infection using rapid diagnostic test, microscopy and PCR. Plasma samples from a subset of participants were analysed for antibodies against thirteen P. falciparum and four P. vivax antigens. Associations between household and individual level risk factors, and Plasmodium infections were evaluated using multilevel logistic regression models.
Results
A total of 2753 individuals from 827 households were enrolled in 2018, and 834 individuals from 222 households were enrolled in 2019. Of them, 33 (1.2%) were positive by PCR for P. falciparum in 2018 and none were positive for P. vivax. In 2019, no PCR-positive individuals were detected. All, but one, infections were asymptomatic; all 33 infections were sub-microscopic. Reported history of malaria in the past 12 months (OR = 8.84) and history of travel in the past 14 days (OR = 10.06) were significantly associated with Plasmodium infection. A significant trend of increased seropositivity with age was noted for all 17 antigens. Although adults (≥ 18 years) consistently had the highest seropositivity rates, a sizeable proportion of under-five children were also found to be seropositive. Almost all individuals (99.4%) reported sleeping under an insecticide-treated bed-net, and household indoor residual spray coverage in the 12 months preceding the survey was low (23%). Most participants correctly identified common signs and symptoms of malaria, i.e., fever (96.4%), headache (71.2%), chills (83.2%) and body-ache (61.8%). Almost all participants (94.3%) used government-provided services for treatment of malaria.
Conclusion
This study explored the epidemiology of malaria in two communities in Meghalaya, India, in the context of declining transmission. The presence of widespread asymptomatic infections and seropositivity among under-five children suggest that low-level Plasmodium transmission persists in this region. Implications of the study findings for malaria elimination efforts in low-transmission settings are discussed.
Læs mere Tjek på PubMedPham Thi Minh Huyen, Dang Thi Ngoc Dung, Peter Johann Weiß, Phan Quoc Hoan, Dao Phuong Giang, Ngo Thi Uyen, Nguyen Van Tuan, Ngo Tat Trung, Thirumalaisamy P Velavan, Le Huu Song, Nghiem Xuan Hoan
International Journal of Infectious Diseases, 11.12.2021
Tilføjet 12.12.2021